Texas State University-San Marcos
Teaching Residency Program for Critical Shortage Areas (TRP-CSA)
2012-2013 Application Form for Cohort 3

INSTRUCTIONS:  Please answer all questions to the best of your ability.  The deadline for submission of all applications for TRP-CSA Cohort 3 (June 2012-August 2013) is Thursday, March 1, 2012.

Personal Contact Information

How did you hear about the TRP-CSA program?

Education Background

If you have taken the GRE within the last 5 years, please provide your scores. 

Teaching Interest / Experience

The graduate curriculum associated with this program focuses on three areas:  Mathematics, Science, and Special Education.  Based on your academic preparation and interest, please select an area of concentration.

 In order to become certified as a teacher in Texas at the conclusion of the TRP-CSA program, you will need to pass a content area test, the Texas Examination of Educator Standards (TExES). Please select a Teaching Certification Area that you are most interested in obtaining.

Have you previously earned a teaching certificate? 

 If yes, please indicate the level and content area(s):

Have you ever been, or are you currently enrolled in a teacher preparation program? 

 If yes, please identify the teacher preparation program and period of enrollment.

If yes, did the teacher preparation program include a student teaching experience? 

Have you taken the TExES in a content area? 

If yes, please identify the content area. 

 If you took the TExES, did you pass?

Have you taken a Pre-Admission Content Test (PACT)? 

If yes, please identify the content area. 

If you took the PACT did you pass it? 

References

You must provide contact information for your references and also provide reference forms for them to submit to the TRP-CSA office. The reference forms are located in the Application Materials tab.

Reference 1:

Reference 2:

Reference 3:

Criminal History

Have you ever been convicted of a felony? 

If yes, describe the crime for which you were convicted, location, and date. 

Please indicate "Yes" or "No" after reading the following statements. If you do not respond with either a "Yes" or "No" to each statement, this application cannot be accepted.

 I consent to this application becoming the property of Texas State University.

I waive my right of future access to the contents of my reference letters. 

I consent to the criminal background check that will be conducted. 

Notification of Rights under the Family Educational Right to Privacy Act (FERPA):

Information collected about you through this application may be held by any institution of higher education to which you apply.  With few exceptions, you are entitled on your request to be informed about the collected information.  Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information.  Under section 559.004 of the Texas Government Code, you are entitled to correct information held by any institution to which you apply by contacting the institution  The information that is collected about you will be retained and maintained as required by Texas records rentention laws (Section 441.180 et seq. of the Texas Government Code) and rules.  Different types of information are kept for different periods of time.

If my application is accepted, I agree to abide by the policies, rules and regulations at any college to which I am admitted  I authorize the college to verify the information I have provided.  I certify that the information I have provided is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawl of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.  I understand that officials of my college will use the information submitted on this form to determine my status for residency eligibility.  I authorize the college to electronically access my records regarding the Texas Success Initiative.  I agree to notify the proper officials of the institution of any changes in the information provided.

Additional Application Requirements

TO BE SUBMITTED TO THE TRP-CSA OFFICE BY THE APPLICATION DEADLINE VIA EMAIL, US MAIL OR FAX:

1. Submit cover letter and resume.
2. Submit completed reference forms.
3. Submit copy of transcript(s).
4. Submit responses to essay questions.
5. Apply to the Graduate College.

Only COMPLETE applications will be considered.

Thank you for completing this application.
Be sure to click the "SUBMIT APPLICATION NOW" button below.